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�W2 <br />Nante- Last <br />First jum L'- <br />iddle <br />r / 110 <br />DOB: <br />Race/Sex <br />M'4 S: <br />o 0 <br />Res. Address: <br />city <br />State <br />Zip <br />I <br />Res. Phone: <br />Work Phone: <br />AI '7 <br />The basis for this Notice of Restriction of Use is that on you violated Section ItIO1 6 of the Park <br />Open Space Rulesy,a d/or Section of the Eugene Code, 1971, and/or ORS To wit, you <br />— <br />05 lj�5 'i 4J 107 .- t)l AqA­ 4/-I <br />(Description of the violation.) <br />This restriction of use is effective beginning on-4219a and shall remain in effect until A_V_ - <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />iniormai nearing Must De M <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address-, 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />I I I I <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infonnal hearing <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at )he date and time shown above by: <br />of person issuing/delivering notice) <br />(Signature of person being issued the notice) <br />White Copy: Public works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />